Food for Thought: Mwangaza Tanzania

Rex Foundation board member Carolyn Garcia on Mwangaza Tanzania

Rex Foundation board member Carolyn Garcia says:

“A young therapist started Mwangaza Tanzania to help children with birth defects and environmental poisoning get to hospitals for treatment. She has realized she must help the people to understand modern medicine. This tiny organization of two young people has begun to teach health education in the local primary schools. Hand-washing, boiling the drinking water, basic nutrition, and other simple practices are easily taught and of vital importance to the poor in Tanzania. Helped by a Rex grant, the project has grown and their story is wonderful. Must read!”

Small grants are vitally important in Tanzania; Rex grantee Mwangaza is building a health education program in rural village schools.

By David Large

Emblematic of Africa’s mystique, Tanzania–land of Mount Kilimanjaro, the Serengeti Plain and Lake Victoria–attracts hundreds of thousands of safari-goers and sightseers every year. Few of these tourists, however, share the normal experience of its inhabitants.

Lying just below the equator on the east coast of Africa, this country of 30 million is one of the world’s poorest. The average life expectancy is about 50 years; Tanzania’s child mortality rate (deaths of children under five per 1,000 live births) is 15 times that of the U.S.

Malaria and HIV/AIDS are major killers. Another problem in many parts of the country is excessive fluoride in the local groundwater, causing widespread bone brittleness and orthopedic malformations. Adding to the misery of those with health problems and physical disabilities is the tribal belief that the sufferer is “bewitched”–that their sufferings result from a curse, and that to sympathize is to risk being cursed oneself.

Sometimes they neglect a disabled child. They think “He will not help me later when he grows up; the problem will continue. He will cost me a lot of money. I will have to sell my cows.” They say you will waste your time because everyone knows that he can’t get better. You can’t fix the problem, because it is witchcraft. They believe the child will bring bad luck to the family.

For many children with disabilities in Tanzania’s remote villages, Mwangaza (“beacon” in Swahili) is a lifeline to essential medical services. Founder/director Paula Gremley and Bakari take their Land Cruiser (funded in part by grants from Rex in 2003 and 2004) on “outreach safaris,” seeking out seriously ill children and those with correctable deformities. Once they’ve located these children and assessed their needs, they work with medical and other aid organizations in the area to transport the young patients to the Tanzanian city of Arusha for treatment and corrective surgery.

Says Mwangaza Tanzania’s founder/director Paula Gremley: “When we convince a family to fix a child’s cleft lip or crippling bone deformity, not only have we changed that child’s life, we have shown a community what is possible.”

Mwangaza also addresses local health issues with educational programs and came up with an innovative way to combat the dire effects of local ground water: giant concrete tanks that gather and store rainwater to be used for cooking and drinking, and to mix with well water to dilute the fluoride.

An unassuming, quiet woman and a trained occupational therapist, Gremley becomes passionate when describing her work. She recently visited the Rex office, starting a conversation that continued after she returned to Tanzania.

Rex: You were raised in Chicago, but have lived in Tanzania since 1995. What inspired that odyssey?

Paula Gremley, Mwangaza Tanzania: My younger brother moved to Arusha in 1993 to work as an architect and I went to visit him. On that trip I fell in love with Tanzania and realized that my skills as an occupational therapist could be put to good use there. On that visit I met a woman who dreamed of building a rehab center and was looking for an OT. Two years later I would return to work for her.

I have always been eager to help others, whether through therapy or by being a good friend. My parents raised us to be involved in the community and to help others; they were good examples for us to learn from. My father worked for South Shore Bank, known for its unique approach to community banking, and my mother often did volunteer work. I tease them that they taught me to be part of the community, but they didn’t tell me what community to be part of!

Rex: To date Mwangaza Tanzania has assessed hundreds of patients, whose disabilities range from orthopedic and neurological problems to hearing and vision loss. What is the process of matching them with the best medical resources available?

Mwangaza: I do the initial evaluations in the rural areas and decide what doctor a patient needs to see. I then refer patients to local or visiting doctors and we help them to see the doctor.

We know when visiting doctors are coming and which local doctors and institutions provide the best services for the patient, given their specific diagnosis. Because most of our patients come from rural areas, they have difficulty navigating through town and the hospital system, so we need to help guide them through the process.

Rex: Besides providing corrective surgeries, you also run educational seminars. What topics do you cover and how do you reach people?

Mwangaza: We realized that many of the disabilities and diseases we see are preventable, so we decided to start doing health education in the villages.

We called a meeting of adults and village leaders to teach the first subject we thought was important–the fluoride in the water. Only a few adults came; the village leaders were off at a wildlife seminar they were paid to attend, something we couldn’t afford.

However, 15 children from a local primary school did come, and Amiri said, “Forget this–let’s go to the primary school to teach.”

That was the beginning of the school seminars. We began teaching about the high levels of fluoride in the ground water and the negative effects, including dental and osteofluorosis. We later added lessons about healthy food, as well as malaria, cholera, hygiene and diseases spread by poor hygiene, schistosomiasis, worms and epilepsy. We do seminars in eight primary schools, six to eight times a year.

Rex: What challenges do you encounter practicing Western medicine in a context of tribal beliefs in witchcraft and the dominance of traditional healers?

Mwangaza: Many people cite corruption, poverty and difficulty in accessing services as the biggest barriers to health care in Africa. I find traditional beliefs in witchcraft, some other religious beliefs, and lack of an understanding of basic science to be bigger barriers.

As a Western person, you would conclude that if your stomach hurts and you have diarrhea, you must have eaten something contaminated by bacteria. But someone who knows nothing of basic science has no understanding of what bacteria are and how they can cause stomach problems, and instead attributes disease, poverty and accidents to a curse, or to God’s will. When illness, poverty or misfortune strikes, they first go to the witch doctor. Even if they know they should go to a medical doctor to cure an illness, oftentimes they go to the witch doctor first to learn why they have the disease. People also go to the witch doctor just because they are poor, hoping for a “cure” for their poverty.

Certain forms of traditional healing and witchcraft are beneficial. Herbal medicines can work (the Masaai have a very effective laxative and a method of massage used to treat constipation!) but there is little actual research on what traditional medicines are effective.

This is difficult for many of us who work in the area. We would love to cooperate with the traditional healers but don’t know which medicines actually work, and going to the traditional healer often delays people from seeking the medical care that can save their life. So often a child is brought to the hospital with pneumonia or another infection; because the family delayed seeking treatment from a Western doctor, the infection is so advanced they die before the antibiotics have a chance to work.

One negative social aspect of witchcraft is that if the witch doctor says someone put a curse on you, he will identify that person. Of course, perhaps no one put a curse on you, but he will blame someone, most likely an innocent old lady in the village who will then be ostracized and ridiculed.

Rex: Tell us about your rainwater harvesting program.

Concrete water tanks at village schools collect rainwater for cooking and drinking. They also serve as a canvas for artists.

Mwangaza: When we discovered that there was a high level of naturally occurring fluoride in the local water, I knew that one way to help people get safe water was through rainwater harvesting. It is a very dry area and introducing rainwater harvesting had other benefits too.

I knew a group of Peace Corps workers who had successfully introduced concrete jug rainwater harvesting tanks in their villages. A Peace Corps worker built the first tank at one of our schools. I like the jug design, as opposed to the less expensive underground tanks, because the water is meant to be used for cooking and drinking, and the jug tanks are easier to clean.

The first tank was a big success, and I received support from the Environmental Resources Management Foundation to build a total of 18 tanks at seven primary schools. We teach the kids the link between the ground water and dental and osteofluorosis, and how to use rainwater to protect themselves from the negative effects of the water.

Rex: Besides that effort, you have other non-medical projects, primarily at schools. Examples?

Mwangaza: After we received support for the tanks I realized there were other things the schools could use to practice what we were teaching the kids in the health seminars–we were teaching the children to boil their drinking water and wash their hands after they used the toilet, but there was no place to boil the water or to wash. We designed the Healthy Schools Initiative and asked for funding from ERM.

Over the course of a couple of years we built kitchens, hand washing stations and waste systems (incinerators and compost pits) at five schools. We taught the children how to use and look after the resources. The kitchens encourage boiling water, the hand washing stations good hygiene, and the waste systems promote good sanitation. It is possible to cut down on many diseases through these practices.

Emblematic of Africa’s mystique, Tanzania–land of Mount Kilimanjaro, the Serengeti Plain and Lake Victoria–attracts hundreds of thousands of safari-goers and sightseers every year. Few of these tourists, however, share the normal experience of its inhabitants.

Mwangaza Tanzania’s Amiri Bakari greets the crowd at a village health clinic.

Rex: Have you found opportunities to join forces with other organizations?

Mwangaza: Yes. During the surgical visits we work closely with Selian Hospital and the new ALMC Hospital, both located in Arusha. We also work with Sarah Wallis Rejman, who runs The Plaster House, a young project that looks after our children and the many others who come to Selian and ALMC for orthopedic and plastic surgery. We work closely with FAME (Foundation for African Medicine and Education) doing mobile clinics to rural areas. FAME supplies medical and nursing professions, both local and overseas volunteers, to provide general medical care to underserved rural communities.

Coordinating the health education is my favorite part of what I am doing these days. It is great to bring medical care to underserved areas, but it is equally important to provide health education so people know why they are sick and how to prevent illness.

I hired an acting troupe, the Sagoma Cultural Acting Troupe, to perform health education in drama, dance and music for a clinic we held in July. We were also joined by volunteers from the Minnesota International Health Volunteers program; they provided a projector to show health education videos. The clinic and the health education programming were big successes. For weeks they were talking about them on the government radio station.

Rex: As you look back to Mwangaza’s founding in 2000, can you see real progress? How do you measure the impacts of your efforts?

Mwangaza: In many ways. When we convince a family to fix a child’s cleft lip or crippling bone deformity, not only have we changed that child’s life, we have shown a community what is possible. We know the impact has extended to others in the community when more and more people request assistance to access the surgical services.

We know we have reached many children and adults though our education programming because we have seen them change their behavior. People are more likely to boil drinking water, wash their hands before meals and seek medical treatment for certain illnesses. We once surveyed the community and learned that the health education we were providing in the schools was brought into the homes by the students we taught.

Rex: What are the biggest obstacles you face?

Mwangaza: Of course, the biggest obstacle, especially this past year, is financing. Raising money takes a lot of hard work, and because of the problems with the economy this year is proving to be especially difficult. We are a small project and have little overhead so I am confident we will survive, but with all I have to do to run things at this end it is hard for me to spend time raising the money we need to continue our work.

We also face problems of corruption, poor infrastructure and unpredictable utility services. At this point I still get frustrated with these problems, but have learned to work around them. Right now, because of a drought, they are rationing power in Tanzania. I have been trying to take care of necessary work on the computer and have not been able to do anything for the past three days without electricity. I also haven’t had hot water for a shower!

Rex: What keeps you going?

Mwangaza: The satisfaction of helping people in positive ways keeps me going. My colleague Amiri Bakari also helps to keep me going. He is an endless source of positive energy and encouragement. He is truly committed to helping his people, and his energy and enthusiasm are infectious.

Rex: What should people reading this know about the problems facing the people of Tanzania, and about Mwangaza’s efforts to help?

Mwangaza: The people of Tanzania face many problems of poverty, disease and disability, and these are all interrelated.Â We are doing what we can to help individuals, changing children’s lives by helping them get a surgical correction for a disability, and for communities by educating people about preventing disease and disability.

You can see an inspiring video about Mwagaza Tanzania’s work at www.mwangaza.org

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